Journal of Urban Health

, Volume 83, Issue 4, pp 669–681 | Cite as

Correlates of Unprotected Sex Among Adult Heterosexual Men Living with HIV

  • Joel Milam
  • Jean L. Richardson
  • Lilia Espinoza
  • Sue Stoyanoff


The correlates of unprotected sex among a sample of heterosexual men living with HIV (n = 121) were examined to determine whether patient characteristics can be used as a basis for tailoring safer sex counseling in the clinic setting. Potential correlates of self-reported unprotected oral sex (fellatio) and vaginal sex included participant demographics (e.g., age, ethnicity), disease status (CD4 counts, viral load, years since diagnosis), safer sex beliefs (e.g., condom attitudes), substance use, psychological characteristics (depressive symptoms, dispositional optimism and pessimism), and sex partner characteristics (main/casual partner, HIV status of partner, and duration of relationship). A series of logistic regression analyses were used to determine significant relationships. Correlates of reported levels of prior 3-month unprotected fellatio (24%) and vaginal (21%) sex were not associated with the type of relationship (main or casual) or perceived HIV serostatus of the partner (positive, negative, or unknown). Unprotected fellatio was positively associated with age and CD4 count and inversely associated with optimism and positive condom attitudes (all p's < 0.05). Unprotected vaginal sex was positively associated with duration of relationship and inversely associated with positive condom attitudes. Prevention efforts among sexually active adult heterosexual men living with HIV may benefit from focusing on improving attitudes towards condom use regardless of partner relationship status.


Condom attitudes Heterosexual HIV Optimism Unsafe sex 


  1. 1.
    Centers for Disease Control. Incorporating HIV prevention into the medical care of persons living with HIV. MMWR. July 18, 2003 2003;52:1–24.Google Scholar
  2. 2.
    Richardson J, Milam J, McCutchan A, et al. Effect of brief provider safer sex counseling for HIV-1 seropositive persons: a multi-clinic assessment. AIDS. 2004;18:1179–1186.PubMedCrossRefGoogle Scholar
  3. 3.
    Wenger NS, Kusseling FS, Beck CK, et al. Sexual behavior of the individuals infected with the human immunodeficiency virus. The need for intervention. Arch Intern Med. 1994;154:1849–1854.PubMedCrossRefGoogle Scholar
  4. 4.
    Wiktor SZ, Biggar RJ, Melbye M, et al. Effect of knowledge of human immunodificiency virus infection status on sexual activity among homosexual men. J Acquir Immune Defic Syndr. 1990;3:62–68.PubMedGoogle Scholar
  5. 5.
    Dukers N, Goudsmit J, deWit J, et al. Sexual risk behavior relates to the virological and immunological improvements during highly active antiretroviral therapy in HIV-1 infection. AIDS. 2001;15:369–378.PubMedCrossRefGoogle Scholar
  6. 6.
    Marks G, Ruiz MS, Richardson J, et al. Anal intercourse and disclosure of HIV infection among seropositive gay and bisexual men. J Acquir Immune Defic Syndr. 1994;7:866–869.PubMedGoogle Scholar
  7. 7.
    Posner SF, Marks G. Prevalence of high-risk sex among HIV-positive gay and bisexual men: a longitudinal analysis. Am J Prev Med. 1996;12:472–477.PubMedGoogle Scholar
  8. 8.
    CDC. Heterosexual transmission of HIV-29 States, 1999–2002. MMWR. February, 20, 2004;53(6):125–129.Google Scholar
  9. 9.
    Sheeran P, Abraham C, Orbell S. Psychosocial correlates of heterosexual condom use: a meta-analysis. Psychol Bull. 1999;125(1):90–132.PubMedCrossRefGoogle Scholar
  10. 10.
    Girardi E, Aloisi MS, Serraino D, et al. Sexual behaviour of heterosexual individuals with HIV infection naïve for antiretroviral therapy in Italy. Sex Transm Infect. 2001;77:130–134.PubMedCrossRefGoogle Scholar
  11. 11.
    Semple SJ, Patterson TL, Grant I. Gender differences in the sexual risk practices of HIV+ heterosexual men and women. AIDS Behav. 2002;6(1):45–54.CrossRefGoogle Scholar
  12. 12.
    Sherr L, Barry N. Fatherhood and HIV positive heterosexual men. HIV Med. 2004;5(4):258–263.PubMedCrossRefGoogle Scholar
  13. 13.
    Colfax GN, Guzman R, Wheeler S, et al. Beliefs about HIV reinfection (superinfection) and sexual behavior among a diverse sample of HIV-positive men who have sex with men. J Acquir Immune Defic Syndr. 2004;36(4):990–992.PubMedCrossRefGoogle Scholar
  14. 14.
    Crepaz N, Marks G. Towards an understanding of sexual risk behavior in people living with HIV: a review of social, psychological, and medical findings. AIDS. 2002;16:135–149.PubMedCrossRefGoogle Scholar
  15. 15.
    Kline A, VanLandingham M. HIV-infected women and sexual risk reduction: the relevance of existing models of behavior change. AIDS Educ Prev. 1994;6(5):390–402.PubMedGoogle Scholar
  16. 16.
    Hays RB, Paul J, Ekstrand M, Kegeles S, Stall R, Coates TJ. Actual versus perceived HIV status, sexual behaviors and predictors of unprotected sex among young gay and bisexual men who identify as HIV-negative, HIV-positive, and untested. AIDS. 1997;11(12):1495–1502.PubMedCrossRefGoogle Scholar
  17. 17.
    Kalichman SC, Kelly JA, Rompa D. Continued high-risk sex among HIV seropositive gay and bisexual men seeking HIV prevention services. Health Psychol. 1997;16(4):369–373.PubMedCrossRefGoogle Scholar
  18. 18.
    Crowell TL. Seropositive individuals willingness to communicate, self-efficacy, and assertiveness prior to HIV infection. J Health Commun. 2004;9(5):395–424.PubMedCrossRefGoogle Scholar
  19. 19.
    Fisher JD, Kimble Willcutts DL, Misovich SJ, Weinstein B. Dynamics of sexual risk behavior in HIV-infected men who have sex with men. AIDS Behav. 1997;2(2):101–113.CrossRefGoogle Scholar
  20. 20.
    Semple SJ, Patterson TL, Grant I. HIV-positive gay and bisexual men: predictors of unsafe sex. AIDS Care. 2003;15(1):3–15.PubMedCrossRefGoogle Scholar
  21. 21.
    Carvajal SC, Garner RL, Evans RI. Dispositional optimism as a protective factor in resisting exposure in sexually active inner-city minority adolescents. J Appl Soc Psychol. 1998;28:2196–2211.CrossRefGoogle Scholar
  22. 22.
    Morrill AC, Ickovics JR, Golubchikov VV, Beren SE, Rodin J. Safer sex: social and psychological predictors of behavioral maintenance and change among heterosexual women. J Consult Clin Psychol. 1996;64(4):819–828.PubMedCrossRefGoogle Scholar
  23. 23.
    Perkins DO, Leserman J, Murphy C, Evans DL. Psychosocial predictors of high-risk sexual behavior among HIV-negative homosexual men. AIDS Educ Prev. 1993;5(2):141–152.PubMedGoogle Scholar
  24. 24.
    Taylor SE, Kemeny ME, Aspinwall LG, Schneider SG, Rodriguez R, Herbert M. Optimism, coping, psychological distress, and high-risk sexual behavior among men at risk for acquired immunodeficiency syndrome (AIDS). J Pers Soc Psychol. 1992;63(3):460–473.PubMedCrossRefGoogle Scholar
  25. 25.
    Kelly JA, Murphy DA, Bahr GR, et al. Factors associated with severity of depression and high-risk sexual behavior among persons diagnosed with human immunodeficiency virus (HIV) infection. Health Psychol. 1993;12(3):215–219.PubMedCrossRefGoogle Scholar
  26. 26.
    Marks G, Bingman CR, Duval TS. Negative affect and unsafe sex in HIV-positive men. AIDS Behav. 1998;2(2):89–99.CrossRefGoogle Scholar
  27. 27.
    Wolitski RJ, Bailey CJ, O'Leary A, Gómez CA, Parsons JT. Self-perceived responsibility of HIV-seropositive men who have sex with men for preventing HIV transmission. AIDS Behav. 2003;7(4):363–372.PubMedCrossRefGoogle Scholar
  28. 28.
    Kalichman SC. Psychological and social correlates of high-risk sexual behaviour among men and women living with HIV/AIDS. AIDS Care. 1999;11(4):415–428.PubMedCrossRefGoogle Scholar
  29. 29.
    Varghese B, Maher JE, Peterman TA, Branson BM, Steketee RW. Reducing the risk of sexual HIV transmission: quantifying the per-act risk of HIV on the basis of choice of partner, sex act, and condom use. Sex Transm Infect. 2002;29(1):38–43.Google Scholar
  30. 30.
    Milam J, Richardson J, McCutchan A, et al. Effect of a brief antiretroviral adherence intervention delivered by HIV care providers. J Acquir Immune Defic Syndr. 2005;40(3):356–363.PubMedCrossRefGoogle Scholar
  31. 31.
    Helweg-Larsen M, Collins BE. The UCLA multidimensional condom attitudes scale: documenting the complex determinants of condom use in college students. Health Psychol. 1994;13(3):224–237.PubMedCrossRefGoogle Scholar
  32. 32.
    Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.CrossRefGoogle Scholar
  33. 33.
    Scheier MF, Carver CS, Bridges MW. Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the life orientation test. J Pers Soc Psychol. 1994;67(6):1063–1078.PubMedCrossRefGoogle Scholar
  34. 34.
    Robinson-Whelen S, Kim C, MacCallum RC, Kiecolt-Glaser JK. Distinguishing optimism from pessimism in older adults: is it more important to be optimistic or not to be pessimistic? J Pers Soc Psychol. 1997;73:1345–1353.PubMedCrossRefGoogle Scholar
  35. 35.
    Padian NS, O'Brien TR, Chang YC, Glass S, Francis DP. Prevention of heterosexual transmission of human immunodificiency virus through couple counseling. J Acquir Immune Defic Syndr. 1993;6:1043–1048.PubMedGoogle Scholar
  36. 36.
    Parsons JR, Huszti HC, Crudder SO, Rich L, Medoza J. Maintenance of safer sexual behaviors: evaluation of a theory based intervention of HIV seropositive men with hemophilia and their female partners. Hemophilia. 2000;6:181–190.CrossRefGoogle Scholar
  37. 37.
    Gielen AC, Fogarty L, Armstrong K, et al. Promoting condom use with main partners: a behavioral intervention trial for women. AIDS Behav. 2001;5:193–204.CrossRefGoogle Scholar
  38. 38.
    van der Straten A, Gomez CA, Saul J, et al. Sexual risk behaviors among heterosexual HIV serodiscordant couples in the era of post-exposure prevention and viral supressive therapy. AIDS. 2000;14:F47–F54.PubMedCrossRefGoogle Scholar
  39. 39.
    Marks G, Crepaz N. HIV-positive men's sexual practices in the context of self-disclosure of HIV status. J Acquir Immune Defic Syndr. 2001;27:79–85.PubMedGoogle Scholar
  40. 40.
    Perry SW, Card CA, Moffat M, Ashman T, Fishman B, Gacobsberg LB. Self-disclosure of HIV infection to sexual partners after repeated counseling. AIDS Educ Prev. 1994;6:403–411.PubMedGoogle Scholar
  41. 41.
    Robbins AS, Spence JT, Clark H. Psychological determinants of health and performance: the tangled web of desirable and undesirable characteristics. J Pers Soc Psychol. 1991;61:755–765.PubMedCrossRefGoogle Scholar
  42. 42.
    Carvajal SC, Clair SD, Nash SG, Evans RI. Relating optimism, hope, and self-esteem to social influences in deterring substance use in adolescents. J Soc Clin Psychol. 1998;17:443–465.Google Scholar
  43. 43.
    Carvajal SC, Wiatrek DE, Evans RI, Knee CR, Nash SG. Psychosocial determinants of the onset and escalation of smoking: cross-sectional and prospective findings in multiethnic middle school samples. J Adolesc Health. 2000;27(4):255–265.PubMedCrossRefGoogle Scholar
  44. 44.
    Bosompra K, Ashikaga T, Flynn BS, Worden JK, Solomon LJ. Psychosocial factors associated with the public's willingness to pay for genetic testing for cancer risk: a structural equations model. Health Educ Res. 2001;16(2):157–172.PubMedCrossRefGoogle Scholar
  45. 45.
    Aspinwall LG, Brunhart SM. Distinguishing optimism from denial: optimistic beliefs predict attention to health threats. Pers Soc Psychol Bull. 1996;10:993–1003.CrossRefGoogle Scholar
  46. 46.
    Richardson J, Milam J, McCutchan A, et al. Using patient risk indicators to plan HIV prevention strategies in the clinical care setting. J Acquir Immune Defic Syndr. 2004;37:S88–S94.PubMedCrossRefGoogle Scholar
  47. 47.
    Kalichman SC, Rompa D, Cage M, et al. Effectiveness of an intervention to reduce HIV transmission risks in HIV-positive people. Am J Prev Med. 2001;21:84–92.PubMedCrossRefGoogle Scholar
  48. 48.
    Paterson TL, Shaw WS, Semple SJ. Reducing sexual risk behaviors of HIV+ individuals: outcome of a randomized controlled trial. Annals Behav Med. 2003;25:137–145.CrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2006

Authors and Affiliations

  • Joel Milam
    • 1
  • Jean L. Richardson
  • Lilia Espinoza
  • Sue Stoyanoff
  1. 1.Department of Preventive MedicineUniversity of Southern CaliforniaLos AngelesUSA

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